Laparoscopic suture device with autoloading and suture capture

ABSTRACT

A suturing device provided. The suturing device may include at least a firing aperture, a drive mechanism and an autoloading mechanism. The firing aperture may include at least one needle rotatably disposed therein configured to engage a suture for deployment. The drive mechanism may be operatively coupled to the needle and configured to advance the needle from a retracted position to an extended position during engagement, and retract the needle from the extended position to the retracted position during disengagement. The autoloading mechanism may be operatively coupled to the drive mechanism and configured to slidably retrieve and position a suture to be deployed over the firing aperture during disengagement of the drive mechanism.

CROSS-REFERENCE TO RELATED APPLICATION

This is a non-provisional US patent application claiming priority under35 U.S.C. §119(e) to U.S. Provisional Patent Application No. 61/882,905filed on Sep. 26, 2013.

FIELD OF THE DISCLOSURE

The present disclosure generally relates to medical fastening devices,and more particularly, relates to sutures and suturing devices forfastening tissue and/or prosthetic material.

BACKGROUND OF THE DISCLOSURE

The fastening of tissues has long been a need in the medical industry,and correspondingly, a finite number of fastening devices have beendeveloped for different applications and uses. Among these devices arelaparoscopic fastening devices or tackers which are often used withminimally invasive procedures such as laparoscopic repair of hernias,and the like. A typical laparoscopic procedure involves the insertion ofthin, elongated instruments into relatively small incisions or accessports in the abdomen to access hernia defects in the abdominal wall fromthe inside. Moreover, the laparoscopic instruments are used to positiona prosthetic mesh over the defect and fasten the prosthetic mesh againstthe inner abdominal wall using tacks, or the like.

Conventional laparoscopic tackers provide a relatively thin andelongated tubular member containing deployable tacks and having anend-firing mechanism positioned at the distal tip thereof. Inparticular, the end-firing mechanism is configured to deploy tacksdirectly from the tip of the elongated member in an axial manner, andthus, ideal application suggests positioning the elongated memberperpendicularly against the tissue surface to be tacked. However, due toseveral factors, such as the relatively rigid and elongated nature ofthe laparoscopic tacker, the limited locations and number of accessports available, and the typical location of hernia defects, it isdifficult to position the end of the laparoscopic device squarelyagainst the inner wall of the abdomen. In practice, a surgeon using alaparoscopic tacker typically positions the tacker with one hand,sometimes even slightly bending the instrument, while using his otherhand to press against the outer wall of the abdomen in order to achievethe best possible angle for installing the tacks.

Furthermore, due to the limited access to hernia defects and theminimally invasive nature of typical hernia repairs, laparoscopictackers tend to use simple-action type mechanisms to deploy tacks, andcorrespondingly, employ tacks with basic means for fastening prostheticmesh to the inner abdominal wall. More specifically, conventionaltackers employ screw-type or simple push-type actions to install tackswith threads or barbs which help embed the tacks within abdominaltissue. Over time, especially in the case of metal, coil-like tacks,these tacks may cause irritation or pain to the patient, becomedislodged from the abdominal wall, or cause other complicationspost-surgery. To address such drawbacks associated with metal tacks,absorbable tacks have been developed and employed. Absorbable tacks aredesigned to be eventually absorbed by the body, and thus, cause lessirritation or pain to the patient over time. However, absorbable tacksalso tend to provide holding or tensile strength that is less thanoptimal. In such cases, suturing the hernia defects or suturingprosthetic mesh to the abdominal wall may prove to be more effective.Even still, the relatively complex nature involved with suturing makesit difficult to use sutures on hernia defects via laparoscopic orotherwise minimally invasive procedures.

Accordingly, there is a need for minimally invasive or laparoscopicmeans of tissue fastening or installing sutures in tissue whichsubstantially facilitates the installation process for the surgeon oruser. There is also a need for a medical fastening device which providesa more effective and reliable means for closing tissue and/or fasteningprosthetic mesh to tissue. Furthermore, there is a need for a medicalfastening device which employs fasteners that reduce irritation, pain,and other complications to the patient without adversely affectingtissue holding strength.

SUMMARY OF THE DISCLOSURE

In accordance with one aspect of the disclosure, a suturing device isprovided. The suturing device may include at least a firing aperture, adrive mechanism and an autoloading mechanism. The firing aperture mayinclude at least one needle rotatably disposed therein configured toengage a suture for deployment. The drive mechanism may be operativelycoupled to the needle and configured to advance the needle from aretracted position to an extended position during engagement, andretract the needle from the extended position to the retracted positionduring disengagement. The autoloading mechanism may be operativelycoupled to the drive mechanism and configured to slidably retrieve andposition a suture to be deployed over the firing aperture after a priorsuture has been deployed.

In accordance with another aspect of the disclosure, a suturing deviceis provided. The suturing device may include at least an elongatemember, a drive mechanism and an autoloading mechanism. The elongatemember may extend between a working end and a control end, and include atrack for receiving one or more deployable sutures therein. The workingend may include a firing aperture disposed in communication with thetrack, and a distal needle and a proximal needle rotatably disposedtherein. The drive mechanism may be disposed within the elongate memberand configured to operatively couple the control end with each of thedistal and proximal needles. The drive mechanism may be configured toadvance each of the distal and proximal needles from a retractedposition to an extended position during engagement, and retract each ofthe distal and proximal needles from the extended position to theretracted position during disengagement. The autoloading mechanism maybe disposed along the elongate member and proximate the working end. Theautoloading mechanism may be operatively coupled to the drive mechanismand configured to slidably retrieve and position one of the deployablesutures over the firing aperture for deployment after a prior suture hasbeen deployed.

In accordance with yet another aspect of the disclosure, a tissuefastener is provided. The tissue fastener may include at least anelongated filament extending between a first end and a second end, aneedle guide disposed on at least one of the first and second endsconfigured to be at least partially engaged by a needle duringdeployment, one or more retention elements disposed on the needle guideconfigured to resist retraction through at least one of a tissue and aprosthetic material, and one or more constriction elements disposed onthe needle guide configured to at least partially constrict the needleguide against the needle during deployment.

These and other aspects and features of the disclosure will be betterunderstood upon reading the following detailed description when takeninto conjunction with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a suturing device constructed inaccordance with the teachings of the present disclosure;

FIG. 2 is a partial perspective view of the working end of a suturingdevice with fully retracted first and second needles;

FIG. 3 is a partial perspective view of the working end of a suturingdevice with partially extended first and second needles;

FIG. 4 is a cross-sectional side plan view of the working end of asuturing device with first and second needles disposed in the fullyretracted positions;

FIG. 5 is a partial perspective view of the working end of a suturingdevice with first and second needles disposed in the fully retractedpositions;

FIG. 6 is a cross-sectional side plan view of the working end of asuturing device with first and second needles disposed in partiallyextended positions;

FIG. 7 is a partial perspective view of the working end of a suturingdevice with first and second needles disposed in partially extendedpositions;

FIG. 8 is a cross-sectional side plan view of the working end of asuturing device with first and second needles disposed in fully extendedpositions;

FIG. 9 is a partial perspective view of the working end of a suturingdevice with first and second needles disposed in fully extendedpositions;

FIG. 10 is a cross-sectional side plan view of the control end andtriggering mechanism of a suturing device;

FIG. 11 is an exploded perspective view of the control end andtriggering mechanism of a suturing device;

FIG. 12 is a partial perspective view of the control end and triggeringmechanism of a suturing device;

FIG. 13 is a partial perspective view of the control end and triggeringmechanism of a suturing device in the engaged state;

FIG. 14 is a partial perspective view of the control end and triggeringmechanism of a suturing device in the disengaged state;

FIG. 15 is a partial top plan view of the working end, autoloadingmechanism and first and second needles of a suturing device;

FIG. 16 is a partial top plan view of the autoloading mechanism of asuturing device;

FIG. 17 is a partial side plan view of the working end, elongate memberand autoloading mechanism of a suturing device during engagement;

FIG. 18 is a partial side plan view of the working end, elongate memberand autoloading mechanism of a suturing device during disengagement;

FIG. 19 is a partial perspective view of the autoloading mechanism of asuturing device;

FIG. 20 is a partial perspective view of the shuttle of the autoloadingmechanism of a suturing device;

FIG. 21 is a partial perspective view of the working end, first andsecond needles and autoloading mechanism of a suturing device;

FIG. 22 are partial side plan views of the autoloading mechanism of asuturing device during engagement;

FIG. 23 is a partial side plan view of the autoloading mechanism of asuturing device during disengagement;

FIG. 24 is a partial top plan view of the working end and autoloadingmechanism of a suturing device retrieving a suture for deployment;

FIG. 25 is a partial top plan view of the working end and autoloadingmechanism of a suturing device sending a retrieved suture fordeployment;

FIG. 26 is a partial top plan view of the working end and autoloadingmechanism of a suturing device positioning a retrieved suture fordeployment;

FIG. 27 is a partial perspective view of the working end, first andsecond needles and autoloading mechanism of a suturing device duringengagement;

FIG. 28 is a perspective view of one exemplary embodiment of a fastenerhaving constriction elements constructed in accordance with theteachings of the present disclosure;

FIG. 29 is a top plan view of a fastener having constriction elements;

FIG. 30 is a partial perspective view of a fastener with constrictionelements as engaged by first and second needles of a suturing device;

FIG. 31 is a partial perspective view of a fastener with constrictionelements as engaged by first and second needles of a suturing device;

FIG. 32 is a partial perspective view of a fastener with constrictionelements as engaged by first and second needles of a suturing device;

FIG. 33 is a perspective view of another exemplary embodiment of afastener having constriction elements;

FIG. 34 is a top plan view of a fastener having constriction elements;

FIG. 35 is a perspective view of another exemplary embodiment of afastener having constriction elements;

FIG. 36 is a top plan view of a fastener having constriction elements;

FIG. 37 is a perspective view of another exemplary embodiment of afastener having constriction elements;

FIG. 38 is a top plan view of a fastener having constriction elements;

FIG. 39 is a perspective view of another exemplary embodiment of afastener having constriction elements;

FIG. 40 is a top plan view of a fastener having constriction elements;

FIG. 41 is a perspective view of yet another exemplary embodiment of afastener having constriction elements, breakaway tabs and nestingelements;

FIG. 42 is a top plan view of a fastener having constriction elements,breakaway tabs and nesting elements; and

FIG. 43 is a perspective view of a string of fasteners, each havingconstriction elements, breakaway tabs and nesting elements.

While the present disclosure is susceptible to various modifications andalternative constructions, certain illustrative embodiments thereof havebeen shown in the drawings and will be described below in detail. Itshould be understood, however, that there is no intention to limit thepresent invention to the specific forms disclosed, but on the contrary,the intention is to cover all modifications, alternative constructionsand equivalents falling within the spirit and scope of the presentdisclosure.

DETAILED DESCRIPTION

Referring now to the drawings, and with specific reference to FIG. 1, amedical fastening or suturing device constructed in accordance with theteachings of the present disclosure is generally referred to byreference numeral 20. The suturing device 20, as will be described infurther detail herein, may advantageously enable convenient yeteffective means of providing fasteners within a surgical environment.The disclosed embodiments may additionally facilitate the installationof fasteners or sutures during minimally invasive surgical procedures,such as laparoscopic procedures, and the like. As used for laparoscopictreatment of a hernia, the embodiment of FIG. 1, for example, may beemployed to reach beneath sections of tissue, within or around theabdominal region, to fasten tissues of the abdominal wall or to fastenprosthetic mesh to the abdominal wall from the inside. Although theembodiments disclosed herein demonstrate tissue fastening as applied tolaparoscopic applications, it will be understood that the presentdisclosure may be equally or similarly applied to other medicalprocedures.

As shown in FIG. 1, the suturing device 20 may generally include anelongate member 22 which extends between a control end 24 disposed at aproximal end thereof, and a working end 26 disposed at a distal endthereof. The control end 24 may generally include a grip 28 as well as atriggering mechanism 30, or any other suitable means for receiving inputor triggering actions from a user and converting the input or actionsinto a suturing action that is performed at the working end 26 of thesuturing device 20. The working end 26 may generally be configured witha firing aperture 32, or a fastening interface disposed at alongitudinal side thereof, through which fasteners or sutures 34 may bedeployed or installed in tissue and/or prosthetic material. Furthermore,one or more of the sutures 34 to be deployed may be provided along theelongate member 22 and distally advanced or fed toward the firingaperture 32 of the working end 26, for example, along one or more guidesor tracks 36 longitudinally disposed within the elongate member 22.

As shown in more detail in FIGS. 2 and 3, the working end 26 of thesuturing device 20 of FIG. 1 may at least partially enclose a firstneedle 38 and a second needle 40, each of which may be substantiallyconcealed within the firing aperture 32 of the working end 26 in adefault or fully retracted position. More specifically, the first needle38 may be rotatably and pivotally disposed about a first fixed axis 42,and the second needle 40 may be rotatably and pivotally disposed about asecond fixed axis 44. Moreover, the first axis 42 may be axially offsetbut substantially parallel to the second axis 44, for example, such thatthe first needle 38 is distally positioned relative to the suturingdevice 20 and the second needle 40 is proximally positioned relative tothe suturing device 20. In other alternative embodiments, each of thefirst and second needles 38, 40 may be coaxially disposed about a commonaxis. In still further embodiments, a single needle or more than twoneedles may be disposed within the firing aperture 32 and comprise anyone of a plurality of different arrangements.

Still referring to FIGS. 2 and 3, each of the first and second needles38, 40 may be configured to rotate in opposing directions betweenrespective retracted and extended positions. For example, duringadvancement, the first or distal needle 38 may be configured toproximally rotate toward the elongate member 22, while the second orproximal needle 40 may be configured to distally rotate away from theelongate member 22. Conversely, during retraction, the first needle 38may be configured to distally rotate away from the elongate member 22,while the second needle 40 may be configured to proximally rotate towardthe elongate member 22. Moreover, each of the first and second needles38, 40 may be configured to advance and retract between respectiveretracted and extended positions simultaneously, or in substantiallyequal increments or at substantially equal rates of angulardisplacement. Each of the first and second needles 38, 40 may furthercomprise a low-profile arcuate geometry which enables the needles 38, 40to be substantially concealed within the firing aperture 32 while in thefully retracted position, and have maximized reach during advancement.Furthermore, each arcuate needle 38, 40 may be shaped and/or otherwiseconfigured to rotate in a cammed fashion such that, it creates aprogressively tighter pull as it travels through the tissue, and thus,creates a tighter fastening of the tissue.

In addition, each of the first and second needles 38, 40 of FIGS. 2 and3 may include one or more of needle hooks 46, grooves, tines, recesses,canted surfaces, or any other suitable structure configured to enableengagement with a fastener or suture 34, or one or more needle guides 48thereof. As shown in FIGS. 2 and 3, for example, a hook 46 may bedisposed on an outer edge of each of the first and second needles 38, 40and configured to engage with a needle guide 48 of a suture 34 as therespective needle 38, 40 is retracted from the fully extended position.While the embodiments of FIGS. 2 and 3 may depict the needles 38, 40with retrograde-type hooks 46 configured to engage a suture 34 duringretraction, it will be understood that other configurations may beequally or similarly employed, such as antegrade-type hooks configuredto engage a suture 34 during advancement, or the like. In still furtheralternatives, one or more hooks may be disposed on an inner edge of eachof the needles 38, 40.

Turning now to FIGS. 4-9, more detailed drawings of the first and secondneedles 38, 40 are provided illustrating the relative rotationalpositions thereof as the needles 38, 40 are advanced from fullyretracted positions to fully extended positions. As shown, each of thefirst and second needles 38, 40 may be operatively coupled to a drivemechanism 50 that is configured to advance the needles 38, 40 from theretracted positions to the extended positions during an engagement ofthe drive mechanism 50 received via the control end 24 of the suturingdevice 20, and conversely, to retract the needles 38, 40 from theextended positions to the retracted positions during a disengagement ofthe drive mechanism 50 received via the control end 24. Furthermore, thedrive mechanism 50 may include a multi-bar linkage, such as a three-barlinkage, or the like, which operatively couples the control end 24 toeach of the first and second needles 38, 40.

As shown in FIGS. 4-9, the drive mechanism 50 may include at least afirst drive link 52 for driving the first needle 38 and a second drivelink 54 for driving the second needle 40, each of which may be slidablydisposed within the elongate member 22 and in operative communicationbetween the control end 24 and the working end 26. The drive mechanism50 may additionally include a first intermediate link 56 for driving thefirst needle 38 and a second intermediate link 58 for driving the secondneedle 40, each of which may configured to pivotally couple thecorresponding drive link 52, 54 to the corresponding needle 38, 40. Inother modifications, one or more links may be omitted or added to thedrive mechanism 50. As the needles 38, 40 are opposedly arranged, thedrive links 52, 54 and the intermediate links 56, 58 may be configuredto be slidably and pivotally driven in substantially equal increments orrates of displacement, but in opposing directions relative to oneanother. For example, during advancement, the first drive link 52 of thefirst needle 38 may be slidably driven distally toward the working end26 at substantially the same rate or in similar increments as the seconddrive link 54 of the second needle 40 being driven proximally away fromthe working end 26.

In the fully retracted positions, as shown in FIGS. 4 and 5 for example,each of the first and second needles 38, 40 may be substantiallyconcealed beneath the firing aperture 32 and within the working end 26of the suturing device 20 so as to facilitate insertion thereof intominimal incisions or access ports, or the like. The first and secondneedles 38, 40 may further include a low-profile geometry which enablesthe working end 26 of the suturing device 20 as well as the access portsto be generally smaller in size. During advancement or during engagementof the drive mechanism 50, as shown in FIGS. 6 and 7 for example, thefirst drive link 52 may drive or push the first intermediate link 56toward the distal end of the firing aperture 32 thereby causing thefirst needle 38 to rotate about the first fixed axis 42 and upwardlyextend from the distal end of the firing aperture 32, while the seconddrive link 54 may drive or pull the second intermediate link 58 towardthe proximal end of the firing aperture 32 thereby causing the secondneedle 40 to rotate about the second fixed axis 44 and upwardly extendfrom the proximal end of the firing aperture 32. Moreover, the drivemechanism 50 may be configured to rotatably extend the needles 38, 40such that the reach of each needle 38, 40 is maximally extended duringadvancement even with a low-profile geometry so as to sufficientlypenetrate tissue and/or prosthetic material to be fastened or sutured.

The drive mechanism 50 may continue advancing each of the first andsecond needles 38, 40 until the needles 38, 40 respectively reach thefully extended positions, as shown for example in FIGS. 8 and 9. Inparticular, the drive mechanism 50 may be configured such that each ofthe first and second needles 38, 40 extend until at least one or more ofthe hooks 46 thereof engage with a fastener or suture 34 for deployment.For example, positioning of the first and second needles 38, 40, thedrive mechanism 50, the firing aperture 32, and the sutures 34 may beconfigured such that retrograde-type hooks 46 on the outer edges of theneedles 38, 40 are able to fully engage with one or more correspondingneedle guides 48 of a given suture 34. In other alternatives, each ofthe needles 38, 40 may employ a retrograde-type hook disposed on theinner edge thereof, an antegrade-type hook disposed on the outer edgethereof, an antegrade-type hook disposed on the inner edge thereof, orany other suitable variation thereof, to which each of the drivemechanism 50, the firing aperture 32, and the like, may be modified toenable sufficient engagement with the corresponding needle guide 48 of agiven suture 34.

Once the first and second needles 38, 40 respectively reach the fullyextended positions thereof as shown for example in FIGS. 8 and 9, andonce a suture 34 is fully engaged, the drive mechanism 50 may bereleased or disengaged, so as to retract the needles 38, 40 and deploythe engaged suture 34 within tissue and/or prosthetic material to befastened. Moreover, the needles 38, 40 may be retracted toward thepositions shown in FIGS. 4 and 5 by substantially reversing the drivemechanism 50. During retraction or during disengagement of the drivemechanism 50, for example, the first drive link 52 may drive or pull thefirst intermediate link 56 toward the proximal end of the firingaperture 32 thereby causing the first needle 38 to rotate in reverseabout the first fixed axis 42 and downwardly retract into the distal endof the firing aperture 32. Correspondingly, the second drive link 54 maydrive or push the second intermediate link 58 toward the distal end ofthe firing aperture 32 thereby causing the second needle 40 to rotate inreverse about the second fixed axis 44 and downwardly retract into theproximal end of the firing aperture 32. Furthermore, each of the firstand second needles 38, 40 may be retracted until the needles 38, 40return to the fully retracted positions of FIGS. 4 and 5 and until apreviously engaged suture 34 is completely deployed and releasedtherefrom, at which point the needles 38, 40 may be advanced again toengage with a new suture 34 for deployment.

While one possible implementation is provided in the drawings, otherdrive mechanisms and configurations therefor will be apparent to thoseskilled in the art without departing from the scope of the appendedclaims. For example, in other modifications, the suturing device 20 mayemploy more than two needles which, for instance, partially oppose oneanother, or alternatively, rotate in like manner and direction relativeto one another. In alternative modifications, the needles 38, 40 may beconfigured to be rotated sequentially rather than simultaneouslyrelative to one another, and/or configured to be rotated atnon-identical rates of angular displacement relative to one another. Inadditional modifications, the needles 38, 40 may be configured to rotateabout a common axis rather than axially offset. In furthermodifications, the suturing device 20 may provide a needle that isconfigured to rotate about an axis that is parallel, or otherwisegenerally not perpendicular, to the elongate member 22. In still furthermodifications, the working end 26 of the suturing device 20 may bearticulated, such as pivotable or otherwise movable, relative to theelongate member 22 about one or more axes.

Referring now to FIGS. 10-14, one exemplary triggering mechanism 60 thatmay be employed to operate the drive mechanism 50 of FIGS. 2-9 isprovided. As shown, the triggering mechanism 60 may be disposed within ahousing 62 provided at the control end 24 of the suturing device 20 andconfigured to interface with the first and second needles 38, 40 via theelongate member 22 and the drive mechanism 50 disposed therein.Furthermore, one or more of the elongate member 22 and the drivemechanism 50 therein may be rotatably coupled to the housing 62 via arotating collar 64 which may be used to adjust the radial position ofthe firing aperture 32 relative to the control end 24. The housing 62may further provide a grip 66 relative to which a trigger 68 of thetriggering mechanism 60 may be pivotally anchored by an anchoring pin 70and movable in one of two directions. For example, the trigger 68 may beconfigured to engage the drive mechanism 50 and advance the needles 38,40 when pulled toward the grip 66, and disengage the drive mechanism 50and retract the needles 38, 40 when pushed away from the grip 66.Correspondingly, as shown in FIG. 10, the trigger 68 may be providedwith a proximal handle 72 for pulling the trigger 68 toward the grip 66,as well as a distal handle 74 for pushing the trigger 68 away from thegrip 66.

Still referring to FIG. 10, the triggering mechanism 60 may furtherinclude a yoke 76 that is rigidly and axially coupled to the elongatemember 22 and rotatably disposed within the housing 62. The triggeringmechanism 60 may additionally include a drive collar 78 that is axiallymovable relative to the yoke 76 and pivotally anchored to the trigger 68via a lynch pin 80. Furthermore, as shown in FIGS. 10-14, the interfacebetween the drive collar 78 and the lynch pin 80 may be configured suchthat the drive collar 78 is pivotally anchored to the trigger 68irrespective of the rotational position of the drive collar 78 relativeto the trigger 68 and the housing 62. The drive collar 78 mayadditionally be linked to the yoke 76 via a collar link 82 and areversing lever 84 such that the rotational position of the drive collar78 follows the rotational position of the yoke 76. As shown in FIGS.10-14, for example, the proximal end of the collar link 82 may bepivotally as well as radially coupled to the drive collar 78, and thedistal end of the collar link 82 may be pivotally and radially coupledto the yoke 76.

The triggering mechanism 60 of FIGS. 10-14 may further provide means fortranslating a single action received by a user at the control end 24 ofthe suturing device 20 into two or more simultaneous but opposingactions effectuated at the working end 26. For example, the distal endof the collar link 82 may be coupled to the yoke 76 via a reversinglever 84, the substantial center of which may be pivotally anchored tothe yoke 76. In particular, a first end of the reversing lever 84 may bepivotally coupled to a first sliding block 86 that is rigidly coupled tothe first drive link 52 but slidably movable relative to the yoke 76.Correspondingly, a second end of the reversing lever 84, opposite thefirst end, may be pivotally coupled to a second sliding block 88 that isrigidly coupled to the second drive link 54 but also slidably movablerelative to the yoke 76. In addition, the collar link 82 may bepivotally coupled proximate and biased to one of the first and secondends of the reversing lever 84 such that, for example, pushing thecollar link 82 in a distal direction rotates the reversing lever 84relative to the yoke 76 in a first direction, and pulling the collarlink 82 in a proximal direction rotates the reversing lever 84 in asecond direction opposite to the first direction.

As illustrated in FIGS. 13 and 14, for example, the collar link 82 maybe coupled proximate to the second end of the reversing lever 84 whichmay further be coupled to the second sliding block 88. In thisparticular arrangement, when the trigger 68 is moved toward the grip 66as indicated by the arrow in FIG. 13, the drive collar 78 and the collarlink 82 may be pulled toward the control end 24 of the suturing device20, thereby causing the reversing lever 84 to pivot in the manner shownand slidably urge the first sliding block 86, as well as the first drivelink 52 coupled thereto, in the distal direction while simultaneouslyurging the second sliding block 88, as well as the second drive link 54coupled thereto, in the proximal direction. Moving the trigger 68 in themanner shown in FIG. 13 may thus cause the drive mechanism 50 to engageand actuate the first and second needles 38, 40. Conversely, when thetrigger 68 is moved away from the grip 66 as indicated by the arrow inFIG. 14, the drive collar 78 and the collar link 82 may be pushed towardthe working end 26 of the suturing device 20, thereby causing thereversing lever 84 to pivot in the opposite direction and slidably urgethe first sliding block 86, as well as the first drive link 52, in theproximal direction while simultaneously urging the second sliding block88, as well as the second drive link 54, in the distal direction.Correspondingly, moving the trigger 68 in the manner shown in FIG. 14may cause the drive mechanism 50 to disengage and retract the first andsecond needles 38, 40.

Turning to FIGS. 15-27, the suturing device 20 may additionally includean autoloading mechanism 90 for successively feeding and automaticallyloading one of a plurality of sutures 34 into position relative to thefiring aperture 32 for deployment. As shown in FIGS. 15 and 16, forexample, a plurality of successively deployable sutures 34, in the formof replaceable suture cartridges, suture ribbons, suture strings, or thelike, may be removably inserted along guides or tracks 36 disposedwithin the elongate member 22. The autoloading mechanism 90 may providea pusher member 92 that is also slidably disposed along the tracks 36and configured to successively or incrementally urge the sutures 34toward the firing aperture 32 for deployment. As shown in FIGS. 17 and18 for example, the pusher member 92 may include at least one flexiblepusher tab 94 extending therefrom that is biased so as tounidirectionally interface with one or more catches 96 that are disposedalong one of the first and second drive links 52, 54 of the drivemechanism 50. Moreover, the pusher tab 94 and the catches 96 may beconfigured such that the pusher member 92 urges the sutures 34 towardthe firing aperture 32 during engagement of the drive mechanism 50 oradvancement of the needles 38, 40.

As shown in the particular arrangement of FIGS. 17 and 18, for example,the pusher member 92 may be configured such that at least one pusher tab94 engages with one of the catches 96 disposed on the first drive link52, and thereby moves the pusher member 92 in direct correspondence withthe first drive link 52. In this configuration, as shown in FIG. 17, thepusher member 92 may be urged to push the sutures 34 toward the firingaperture 32 while the first and second drive links 52, 54 are beingengaged and while the first and second needles 38, 40 are beingadvanced. Furthermore, in this particular configuration, when the drivemechanism 50 is being disengaged and when the needles 38, 40 are beingretracted, as shown in FIG. 18, the catches 96 of the first drive link52 may be free to return and move away from the working end 26 while thepusher member 92 remains stationary relative to the sutures 34 and thefiring aperture 32. Moreover, the pusher member 92 may include supportmembers 97 as shown in FIG. 15 configured to essentially wedge thepusher member 92 within the guides or tracks 36 of the elongate member22 and provide the pusher member 92 at least some resistance againstlongitudinal movement therealong. The positioning of the catches 96along the first drive link 52 may be spaced according to the distanceallotted for each suture 34. In addition, the number of catches 96 andthe freedom of travel of the pusher member 92 may also be configured soas to sufficiently adapt to the changing length of the string ofavailable sutures 34 which incrementally shortens after each deployment.

While the embodiments shown may disclose interactions between the pushertab 94 and catches 96 provided on the first drive link 52, the pushertab 94 may alternatively interact with catches 96 disposed on the seconddrive link 54 or any combination of the first and second drive links 52,54. In still further alternative embodiments, the pusher member 92 maybe configured to interact with the drive mechanism 50 in other mannersnot shown, so long as the drive mechanism 50 is able to engage thepusher member 92 to timely and appropriately urge one or more sutures 34toward the firing aperture 32 for deployment upon deployment of a priorsuture 34.

While the pusher member 92 and the catches 96 of the first drive link 52of FIGS. 15-18 may aid in urging the string of sutures 34 toward theworking end 26 for deployment, the extent to which the sutures 34 arepushed may be limited so as not to obstruct the firing aperture 32through which the first and second needles 38, 40 will need to extend inorder to deploy a prior suture 34. Accordingly, the autoloadingmechanism 90, as shown in FIGS. 19-27, may further include a shuttle 98configured to retrieve the next suture 34 in line for deployment andposition the suture 34 over the firing aperture 32 in alignment with theneedles 38, 40 upon full deployment and release of a prior suture 34. Asshown in FIG. 19, the shuttle 98 may be slidably disposed along theelongate member 22 and beneath the string of sutures 34 to be deployed.Moreover, the shuttle 98 may be movably disposed in communicationbetween the working end 26 and the elongate member 22 such that thedistance of travel of the shuttle 98 extends between at least the firingaperture 32 and the next suture 34 in line for deployment.

As shown in FIG. 20, the shuttle 98 may further include one or moresuture pawls 100 for engaging with a suture 34 prior to deployment. Morespecifically, the suture pawls 100 may be configured such that theshuttle 98 is engaging when traveling in one direction but non-engagingwhen traveling in the opposite direction. In the embodiments of FIGS. 19and 20, for example, each of the suture pawls 100 may include a rampededge 102 facing the proximal direction and a hooked edge 104 facing theopposite, distal direction. In addition, each of the suture pawls 100may be formed of a partially flexible material and allowed to deflectwithin recesses 106 formed within the shuttle 98. In such a way, thedeflectable ramped edges 102 may enable the suture pawls 100 and theshuttle 98 to proximally travel from the firing aperture 32 to beneaththe sutures 34 without substantial obstruction and without adverselyaffecting the position of the sutures 34. Once the shuttle 98 is in theappropriate position beneath the next suture 34 in line for deployment,as shown in FIG. 19, the hooked edges 104 may be upright and in positionto slidably engage with the suture 34. As the shuttle 98 returns towardthe working end 26, the hooked edges 104 of the suture pawls 100 maydistally slide the next suture 34 onto the firing aperture 32. Moreover,the suture 34 may be positioned such that any needle guides 48 thereofare appropriately aligned with one or more corresponding needles 38, 40.

Turning to FIG. 21, the autoloading mechanism 90 may further interfacewith the drive mechanism 50 to at least cause the shuttle 98 of FIGS. 19and 20 to move between the firing aperture 32 and the string of suture34. As shown, the autoloading mechanism 90 may include a shuttle pawl108 that is generally disposed beneath the shuttle 98 and coupled to oneof the first and second drive links 52, 54 of the drive mechanism 50.While other configurations are possible, in the particular embodimentsshown, for example, the shuttle pawl 108 may be coupled to the firstdrive link 52. Moreover, the shuttle pawl 108 may include a ramped edge110 facing the distal direction that is configured such that the firstdrive link 52 and the shuttle pawl 108 are freely movable in the distaldirection relative to the shuttle 98 without substantial obstruction orinterference therewith, such as during advancement of the needles 38,40. As illustrated, the shuttle pawl 108 may be formed of a flexiblematerial that can be deflected within a recess 112 of the first drivelink 52. The shuttle pawl 108 may additionally include a hooked edge 114facing the proximal direction that is configured such that the shuttlepawl 108 pulls the shuttle 98 with the first drive link 52 when thefirst drive link 52 moves in the proximal direction, such as duringretraction of the needles 38, 40.

As shown more particularly in FIG. 22, during engagement of the drivemechanism 50 or during advancement of the first and second needles 38,40, the first drive link 52 along with the shuttle pawl 108 may bedistally pushed toward the working end 26 of the suturing device 20 inthe manner shown. As the shuttle pawl 108 approaches the shuttle 98, theramped edge 110 thereof may enable the shuttle pawl 108 to deflect intothe recess 112 of the first drive link 52, and further, enable theshuttle pawl 108 to glide under the shuttle 98 without altering theposition of the shuttle 98 relative to the sutures 34. Each of the firstdrive link 52 and the shuttle pawl 108 may progress in such a way atleast until the hooked edge 114 of the shuttle pawl 108 reaches andinterfaces with the distal end of the shuttle 98. Both the first drivelink 52 and the shuttle pawl 98 may be sized and configured such thatthe hooked edge 114 interfaces with distal end of the shuttle 98 oncethe needles 38, 40 are in the fully extended positions and ready toengage and deploy the prior suture 34 as shown in FIG. 21.Correspondingly, during disengagement of the drive mechanism 50 orduring retraction of the needles 38, 40, the first drive link 52 alongwith the shuttle pawl 108 and the engaged shuttle 98 may be proximallypulled toward the string of sutures 34 so as to retrieve the next suture34 in line for subsequent deployment.

Once the shuttle 98 is sufficiently pulled beneath the next suture 34 tobe deployed, the shuttle pawl 108 may be configured to automaticallyrelease the shuttle 98 so as to enable the shuttle 98 to return to theworking end 26 and send the retrieved suture 34 therewith to theappropriate position over the firing aperture 32. As shown in FIG. 23,for example, the autoloading mechanism 90 may thus provide a declutchfeature, such as a declutch pin 116, or the like, configured to releasethe shuttle pawl 108, or release the shuttle 98 from the first drivelink 52, once the shuttle 98 is appropriately positioned beneath thenext suture 34 in line for deployment. For example, the declutch pin 116may be coupled within the elongate member 22 and fixedly positionedrelative to the shuttle pawl 108 such that, as the shuttle pawl 108proximally passes thereby, the shuttle pawl 108 is caused to deflectwithin the recess 112 of the first drive link 52 and allow the shuttle98 to return to the working end 26. Furthermore, the shuttle pawl 108may further provide a ramped interface 118 which proximally precedes thehooked edge 114 and is configured to sufficiently deflect and releasethe shuttle pawl 108 from the shuttle 98 at the appropriate moment, forinstance, when the suture pawls 100 of the shuttle 98 are ready toengage with the next suture 34 in line for deployment.

Still referring to FIG. 23, once the shuttle pawl 108 is fullydeflected, the shuttle 98 and the retrieved suture 34 may be sent to thefiring aperture 32 by a bias mechanism 120 configured to continuouslybias or urge the shuttle 98 toward the working end 26. As shown, thebias mechanism 120 may employ a compression spring, or the like, that islongitudinally disposed within the elongate member 22 and configured todistally push the shuttle 98 away therefrom. In further modifications,the proximal end of the shuttle 98 may further provide a centering rod122 longitudinally extending therefrom configured to interface with thecompression spring of the bias mechanism 120 and maintain centering ofthe shuttle 98 relative to the elongate member 22 and the firingaperture 32. Similarly, other bias mechanisms 120 may be employed toachieve comparable results so long as the biasing force applied upon theshuttle 98 in the distal direction does not exceed the force exertedthereon in the proximal direction by the shuttle pawl 108 and the firstdrive link 52.

Turning now to FIGS. 24-26, one exemplary embodiment of the autoloadingmechanism 90 is shown as it progressively retrieves the next suture 34in line for deployment, and appropriately positions the suture 34 uponthe firing aperture 32. More specifically, as shown in FIG. 24, theshuttle 98 as well as the suture pawls 100 are proximally pulled towardthe string of sutures 34 as the drive mechanism 50 is disengaged or asthe needles 38, 40 are retracted. As illustrated, the shuttle 98 isproximally pulled until at least the suture pawls 100 are in position toslidably engage respective sections of the suture 34. For instance, eachsuture pawl 100 may be configured to engage an exterior of a needleguide 48 of the suture 34, an interior of a needle guide 48, or anyother portion of the suture 34 that is suitable for carrying the suture34 to the firing aperture 32. Once released, the shuttle 98 and thesuture pawls 100, as well as the next suture 34 to be deployed, may bedistally pushed toward the firing aperture 32 while leaving theremaining string of sutures 34 behind, as shown for instance in FIG. 25.Furthermore, as shown in FIG. 26, the shuttle 98 may continue carryingthe suture 34 toward the firing aperture 32 until each of the needleguides 48 of the suture 34 is appropriately aligned to be engaged by thecorresponding needle 38, 40.

In addition, as shown in FIG. 27, the autoloading mechanism 90 may alsoprovide one or more release mechanisms 124, 126 for completely deployingor releasing an engaged suture 34 from the first and second needles 38,40 during retraction thereof. For example, each release mechanism 124,126 may employ a blade or a cutting edge 128 that is longitudinallydisposed within the firing aperture 32 and fixedly positioned proximatethe retracted position of the corresponding needle 38, 40 such that, asthe needle 38, 40 is retracted back into the firing aperture 32 andrestored to its fully retracted position, the movement thereof relativeto the cutting edge 124 causes the needle guide 48 of the suture 34 tobe cut and released therefrom. In the particular embodiment of FIG. 24,for instance, a first release mechanism 124 is fixedly disposed withinthe firing aperture 32 and proximate the first needle 38, while thesecond release mechanism 126 is fixedly disposed within the firingaperture 32 and proximate the second needle 40. Moreover, in eachrelease mechanism 124, 126, the cutting edge 128 may be specificallypositioned such that an engaged suture 34 is cut and completely releasedby the time the corresponding needle 38, 40 returns to its retractedposition. While only cutting edges 128 are shown, the release mechanisms124, 126 may alternatively employ hooks, pawls, ramped edges, or anysuitable device capable of releasing the suture 34 from the needles 38,40 or hooks 46 thereof either by cutting or unlatching the suture 34therefrom.

Referring now to FIGS. 28 and 29, one exemplary embodiment of a tissuefastener or suture 34 constructed in accordance with the teachings ofthe present disclosure is provided. As shown, the suture 34 maygenerally comprise an elongated filament 130 extending between a firstend and a second end, and at least one needle guide 48 disposed at oneor more of the first and second ends of the elongated filament 130. Thesuture 34 may be unitarily formed of a material that is sufficientlyflexible and compliant so as to be appropriately deployable by asuturing device 20, while also providing sufficient resilience orrigidity to maintain closure between tissue and/or prosthetic materialupon deployment. Additionally, the elongated filament 130 may be formedwith one or more planar curves, such as the S-shaped curve shown, or thelike, so as to provide for a more compact overall package and toincrease the number of sutures 34 that can be made available fordeployment, for example, along the elongated member 22 of a givensuturing device 20. Furthermore, the planar curves of the elongatedfilament 130 may be configured according to the anticipated geometry ofthe suture 34 once deployed and installed within tissue and/orprosthetic material.

Still referring to the sutures 34 of FIGS. 28 and 29, each needle guide48 may be sufficiently sized and configured to be engaged by, forexample, one of the needles 38, 40 of the suturing device 20 of FIG.1-27, or one the needle hooks 46 thereof, while also being sufficientlyeasily released from the needles 38, 40, for example, via any of therelease mechanisms 124, 126 provided in FIGS. 24-27. The needle guides48 may further be shaped, for example, with a relatively tapered tipthat is configured to facilitate advancement thereof through tissueand/or prosthetic material during deployment, as well as resistretraction thereof to promote a secure closure. For example, the needleguides 48 may be shaped in the substantial form of an oval, an ellipse,a circle, a semi-circle, a triangle, a polygon, or the like. As shown,each needle guide 48 may additionally include one or more retentionelements 132 that are also configured to facilitate advancement thereofthrough sections of tissue and/or prosthetic material, and further aidin resisting retraction thereof once deployed. The retention elements132 may be shaped in the form of a tine, a fin, a canted element, or anydesign sufficiently capable resisting retraction through tissue and/orprosthetic material.

Each of the needle guides 48 in FIGS. 28 and 29 may further be providedwith one or more constriction elements 134 configured to further securean engagement between the needle guide 48 and a corresponding needle 38,40 or needle hook 46 thereof. More specifically, the constrictionelement 134 may be disposed within the needle guide 48 in a mannerconfigured to at least partially bias or constrict the needle guide 48against one of the needles 38, 40 received therethrough. As shown inFIGS. 28 and 29, for example, the constriction element 134 may take theform of a tab, flap, or the like, that is disposed within the needleguide 48 and extending toward the tapered end of the needle guide 48 orextending toward any other the portion of the needle guide 48 that isanticipated to be engaged by a needle hook 46. Moreover, theconstriction elements 134 may be formed of a material that issufficiently flexible and compliant so as to receive a needle 38, 40therethrough, but also formed of a material with sufficient resilienceand rigidity so as to bias the needle guide 48 against the needle 38, 40and needle hook 46.

Turning to FIGS. 30-32, one exemplary interaction between the suture 34of FIGS. 28 and 29 and a given set of needles 38, 40 and respectiveneedle hooks 46 is provided. As shown, once the first and second needles38, 40 are advanced into the fully extended positions and receivedthrough the respective needle guides 48, the constriction elements 134are caused to bend, thereby pushing or exerting an outward force againstthe inner edge of the needles 38, 40. This outward pushing force exertedby the constriction element 134 may effectively exert a substantiallyequal and opposite inward force on the tapered end of the needle guide48, thereby biasing the needle guide 48 into the needle hook 46 of therespective needle 38, 40. Thus, the constriction elements 134 of thesutures 34 may provide an otherwise absent constricting force on areceived needle 38, 40, which may further serve to secure an engagementbetween the needle hook 46 and the needle guide 48 of the suture 34.While disclosed in the form of a tab or flap, the constriction elements134 may be provided on the needle guides 48 in any one of variety ofdifferent forms, sizes and configurations. Alternatively, theconstriction element 134 may be configured to substantially close theneedle guide 48 except for one or more slots, apertures or other voidsdisposed toward the tapered end thereof in a manner which wouldeffectively bias the needle guide 48 against a given needle hook 46. Instill further alternatives, the constriction element 134 may becompletely closed but penetrable by a needle 38, 40 in a manner whichwould effectively bias the needle guide 48 against the needle hook 46.

As shown in FIGS. 33 and 34, another exemplary embodiment of a tissuefastener or suture 34-1 that may be used in association with a suturingdevice 20 is provided. Similar to the suture 34 of FIGS. 28 and 29, thesuture 34-1 shown may generally comprise an elongated filament 130-1extending between a first end and a second end, and at least one needleguide 48-1 disposed at one or more of the first and second ends of theelongated filament 130-1. The suture 34-1 may be formed of a materialthat is sufficiently flexible and compliant so as to be appropriatelydeployable by a suturing device 20, while also providing sufficientresilience or rigidity to maintain closure between tissue and/orprosthetic material upon deployment. The elongated filament 130-1 of thesuture 34-1 may further include a cross member 136 as well as filamentguides 138 configured to stabilize the suture 34-1 as it is moved withinthe tracks 36 and along the elongate member 22 of a suturing device 20.For example, the cross member 136 may aid in increasing the structuralintegrity laterally across the suture 34-1 and reduce binding, while thefilament guides 138 may be sized and configured to interface with thetracks 36 of the elongate member 22 of a suturing device 20 so as toprovide the suture 34-1 with additional lateral support and maintainproper alignment thereof. Furthermore, any one or more of the crossmember 136 and the filament guides 138 may be configured with retentionfeatures configured to aid in resisting retraction thereof once deployedinto tissue and/or prosthetic material.

As in previous embodiments, the needle guides 48-1 of FIGS. 33 and 34may be sufficiently sized and configured to be engaged by a needle 38,40 of a suturing device 20, or one of the needle hooks 46 thereof, whilealso being sufficiently thin or easily released from the needles 38, 40,for example, via any of the release mechanisms 124, 126 provided inFIGS. 24-27. As shown, the needle guides 48-1 may be provided with arelatively tapered tip, as well as provided with one or more retentionelements 132-1, configured to facilitate advancement thereof throughtissue and/or prosthetic material during deployment, and resistretraction thereof to promote a secure closure. Each of the needleguides 48-1 in FIGS. 33 and 34 may be provided with constrictionelements 134-1 which substantially conform to the shape of the needleguides 48-1 and serve to secure an engagement between the needle guide48-1 and a corresponding needle 38, 40 or needle hook 46 thereof.Specifically, each constriction element 134-1 may be configured toincrease the integrity or lateral rigidity of each needle guide 48-1when a needle 38, 40 is not inserted therethrough, such as when thesuture 34-1 is being moved along the tracks 36 of the elongate member 22of a suturing device 20, but also configured to effectively reduce thelateral rigidity of each needle guide 48-1 when a needle 38, 40 isreceived therethrough, such as during advancement through tissue and/orprosthetic material. As shown in FIGS. 33 and 34, for example, theconstriction elements 134-1, when in the non-deflected state, maysubstantially fill the width of the needle guides 48-1, and therebyprovide lateral support thereacross. When in the deflected state, theconstriction elements 134-1 may enable the needle guides 48-1 tosubstantially collapse and narrow so as to promote insertion oradvancement thereof through a tissue, and the like. Furthermore, theconstriction elements 134-1 may continue to provide lateral rigidity andsupport for the retention elements 132-1 once deployed and released intotissue and/or prosthetic material. For example, once the suture 34-1 isdeployed and needle guides 48-1 are released, for instance cut, from thecorresponding needles 38, 40, the constriction elements 134-1 may beconfigured to return to the non-deflected default state and therebysubstantially prevent the retention elements 132-1 from collapsing andretracting from the tissue and/or prosthetic material.

As additionally shown in FIGS. 35 and 36, another exemplary embodimentof a tissue fastener or suture 34-2 that may be used in association witha suturing device 20 is provided. As in previous embodiments, the suture34-2 may generally comprise an elongated filament 130-2 extendingbetween a first end and a second end, and at least one needle guide 48-2disposed at one or more of the first and second ends of the elongatedfilament 130-2. The suture 34-2 may be formed of a material that issufficiently flexible and compliant so as to be appropriately deployableby a suturing device 20, while also providing sufficient resilience orrigidity to maintain closure between tissue and/or prosthetic materialupon deployment. The elongated filament 130-2 of the suture 34-2 mayfurther include a cross member 136 as well as filament guides 138configured to stabilize the suture 34-2 as it is moved within the tracks36 and along the elongate member 22 of a suturing device 20.Additionally, any one or more of the cross member 136 and the filamentguides 138 may be configured with retention features configured to aidin resisting retraction thereof once deployed into tissue and/orprosthetic material.

The needle guides 48-2 of FIGS. 35 and 36 may be sufficiently sized andconfigured to be engaged by a needle 38, 40 of a suturing device 20, orone of the needle hooks 46 thereof, while also being sufficiently thinor easily released from the needles 38, 40, for example, via any of therelease mechanisms 124, 126 provided in FIGS. 24-27. The needle guides48-2 may be provided with a relatively tapered tip, as well as providedwith one or more retention elements 132-2, configured to facilitateadvancement thereof through tissue and/or prosthetic material duringdeployment, and resist retraction thereof to promote a secure closure.Each of the needle guides 48-2 in FIGS. 35 and 36 may be provided withconstriction elements 134-2 configured to further secure an engagementbetween the needle guide 48-2 and a corresponding needle 38, 40 orneedle hook 46 thereof. Specifically, each constriction element 134-2may be provided with a widened feature configured to increase theintegrity or lateral rigidity of each needle guide 48-2 when a needle38, 40 is not inserted therethrough, such as when the suture 34-2 isbeing moved along the tracks 36 of the elongate member 22 of a suturingdevice 20, but also configured to effectively reduce the lateralrigidity of each needle guide 48-2 when a needle 38, 40 is receivedtherethrough, such as during advancement through tissue and/orprosthetic material. As shown in FIGS. 35 and 36, for example, thewidened feature of the constriction element 134-2, when in thenon-deflected state, may substantially abut the inner walls of theneedle guide 48-2, and thereby provide lateral support thereacross. Whenin the deflected state, the constriction element 134-2 may enable theneedle guide 48-2 to substantially collapse and narrow so as to promoteinsertion or advancement thereof through a tissue, and the like.Furthermore, the constriction elements 134-2 may continue to providelateral rigidity and support for the retention elements 132-2 oncedeployed and released into tissue and/or prosthetic material. Forexample, once the suture 34-2 is deployed and needle guides 48-2 arereleased, for instance cut, from the corresponding needles 38, 40, theconstriction elements 134-2 may be configured to return to thenon-deflected default state and thereby substantially prevent theretention elements 132-2 from collapsing and retracting from the tissueand/or prosthetic material.

In still further alternatives, another exemplary embodiment of a tissuefastener or suture 34-3 is provided in FIGS. 37 and 38. As in previousembodiments, the suture 34-3 may generally comprise an elongatedfilament 130-3 extending between a first end and a second end, and atleast one needle guide 48-3 disposed at one or more of the first andsecond ends of the elongated filament 130-3. The suture 34-3 may beformed of a material that is sufficiently flexible and compliant so asto be appropriately deployable by a suturing device 20, while alsoproviding sufficient resilience or rigidity to maintain closure betweentissue and/or prosthetic material upon deployment. The elongatedfilament 130-3 of the suture 34-3 may further include a cross member 136as well as filament guides 138 configured to stabilize the suture 34-3as it is moved within the tracks 36 and along the elongate member 22 ofa suturing device 20. Additionally, any one or more of the cross member136 and the filament guides 138 may be configured with retentionfeatures configured to aid in resisting retraction thereof once deployedinto tissue and/or prosthetic material.

The needle guides 48-3 of FIGS. 37 and 38 may be sufficiently sized andconfigured to be engaged by a needle 38, 40 of a suturing device 20, orone of the needle hooks 46 thereof, while also being sufficiently thinor easily released from the needles 38, 40, for example, via any of therelease mechanisms 124, 126 provided in FIGS. 24-27. The needle guides48-3 may be provided with a relatively tapered tip, as well as providedwith one or more retention elements 132-3, configured to facilitateadvancement thereof through tissue and/or prosthetic material duringdeployment, and resist retraction thereof to promote a secure closure.Each of the needle guides 48-3 in FIGS. 37 and 38 may be provided withconstriction elements 134-3 configured to further secure an engagementbetween the needle guide 48-3 and a corresponding needle 38, 40 orneedle hook 46 thereof. Specifically, each constriction element 134-3may be provided with a substantially webbed feature configured toincrease the integrity or lateral rigidity of each needle guide 48-3when a needle 38, 40 is not inserted therethrough, such as when thesuture 34-3 is being moved along the tracks 36 of the elongate member 22of a suturing device 20, but also configured to effectively reduce thelateral rigidity of each needle guide 48-3 when a needle 38, 40 isreceived therethrough, such as during advancement through tissue and/orprosthetic material. As shown in FIGS. 37 and 38, for example, thewebbed feature of the constriction element 134-3, when in thenon-deflected state, may provide rigidity and lateral support againstthe inner walls of the needle guide 48-3. When the constriction element134-3 is at least partially deflected state due to the insertion of aneedle 38, 40, the needle guide 48-3 may be enabled to substantiallycollapse and narrow so as to promote insertion or advancement thereofthrough a tissue, and the like. Furthermore, the constriction elements134-3 may continue to provide lateral rigidity and support for theretention elements 132-3 once deployed and released into tissue and/orprosthetic material. For example, once the suture 34-3 is deployed andneedle guides 48-3 are released, for instance cut, from thecorresponding needles 38, 40, the constriction elements 134-3 may beconfigured to return to the non-deflected default state and therebysubstantially prevent the retention elements 132-3 from collapsing andretracting from the tissue and/or prosthetic material.

Referring now to FIGS. 39 and 40, another exemplary embodiment of atissue fastener or suture 34-4 is provided. As in previous embodiments,the suture 34-4 may generally comprise an elongated filament 130-4extending between a first end and a second end, and at least one needleguide 48-4 disposed at one or more of the first and second ends of theelongated filament 130-4. The suture 34-4 may be formed of a materialthat is sufficiently flexible and compliant so as to be appropriatelydeployable by a suturing device 20, while also providing sufficientresilience or rigidity to maintain closure between tissue and/orprosthetic material upon deployment. The elongated filament 130-4 of thesuture 34-4 may further include a cross member 136 as well as filamentguides 138 configured to stabilize the suture 34-4 as it is moved withinthe tracks 36 and along the elongate member 22 of a suturing device 20.Additionally, any one or more of the cross member 136 and the filamentguides 138 may be configured with retention features configured to aidin resisting retraction thereof once deployed into tissue and/orprosthetic material.

The needle guides 48-4 of FIGS. 39 and 40 may be sufficiently sized andconfigured to be engaged by a needle 38, 40 of a suturing device 20, orone of the needle hooks 46 thereof, while also being sufficiently thinor easily released from the needles 38, 40, for example, via any of therelease mechanisms 124, 126 provided in FIGS. 24-27. The needle guides48-4 may be provided with a relatively tapered tip, as well as providedwith one or more retention elements 132-4, configured to facilitateadvancement thereof through tissue and/or prosthetic material duringdeployment, and resist retraction thereof to promote a secure closure.Each of the needle guides 48-4 in FIGS. 39 and 40 may be provided withconstriction elements 134-4 configured to further secure an engagementbetween the needle guide 48-4 and a corresponding needle 38, 40 orneedle hook 46 thereof. As in the suture 34-3 of FIGS. 37 and 38, theconstriction elements 134-4 of FIGS. 39 and 40 may be provided with awebbed feature configured to increase the integrity or lateral rigidityof each needle guide 48-4 when a needle 38, 40 is not insertedtherethrough, such as when the suture 34-4 is being moved along thetracks 36 of the elongate member 22 of a suturing device 20, but alsoconfigured to effectively reduce the lateral rigidity of each needleguide 48-4 when a needle 38, 40 is received therethrough, such as duringadvancement through tissue and/or prosthetic material. Unlike theprevious suture 34-3, however, the constriction elements 134-4 of thesuture 34-4 of FIGS. 39 and 40 may be arched or otherwise contrastedwith the general plane of the suture 34-4 and biased to exert a lateralforce against the inner walls of the needle guide 48-4 when in thenon-deflected state. When the constriction element 134-4 is at leastpartially deflected due to the insertion of a needle 38, 40, the needleguide 48-4 may be enabled to substantially collapse and narrow so as topromote insertion or advancement thereof through a tissue, and the like.Furthermore, the constriction elements 134-4 may continue to providelateral rigidity and support for the retention elements 132-4 oncedeployed and released into tissue and/or prosthetic material. Forexample, once the suture 34-4 is deployed and needle guides 48-4 arereleased, for instance cut, from the corresponding needles 38, 40, theconstriction elements 134-4 may be configured to return to thenon-deflected default state and thereby substantially prevent theretention elements 132-4 from collapsing and retracting from the tissueand/or prosthetic material.

Referring further to FIGS. 41 and 42, yet another exemplary embodimentof a tissue fastener or suture 34-5 is provided. Similar to previousembodiments, the suture 34-5 may generally comprise an elongatedfilament 130-5 extending between a first end and a second end, and atleast one needle guide 48-5 disposed at one or more of the first andsecond ends of the elongated filament 130-5. The suture 34-5 may beformed of a material that is sufficiently flexible and compliant so asto be appropriately deployable by a suturing device 20, while alsoproviding sufficient resilience or rigidity to maintain closure betweentissue and/or prosthetic material upon deployment. The elongatedfilament 130-5 of the suture 34-5 may also include breakaway tabs 140configured to help stabilize the suture 34-5 as it is moved within thetracks 36 and along the elongate member 22 of a suturing device 20. Asshown, each breakaway tab 140 may be coupled between a needle guide 48-5and a corresponding section of the elongated filament 130-5 in thefolded position, and configured to be detachable upon deployment. Inparticular, the breakaway tabs 140 may be sized and configured toprovide, not only sufficient planar and lateral rigidity to the suture34-5 prior to deployment, but also configured with sufficientdetachability so as not to interfere with the deployment thereof. Asbetter seen in FIG. 42, for example, each of the breakaway tabs 140 mayincorporate attenuated features 142, such as in the form of grooves,slits, perforations, or the like. Furthermore, the breakaway tabs 140may be angled or otherwise positioned relative to the needle guides 48-5in a way to help resist retraction thereof once deployed into tissueand/or prosthetic material.

The needle guides 48-5 of FIGS. 41 and 42 may be sufficiently sized andconfigured to be engaged by a needle 38, 40 of a suturing device 20, orone of the needle hooks 46 thereof, while also being sufficiently thinor easily released from the needles 38, 40, for example, via any of therelease mechanisms 124, 126 provided in FIGS. 24-27. The needle guides48-5 may be provided with a relatively tapered tip, as well as providedwith one or more retention elements 132-5, configured to facilitateadvancement thereof through tissue and/or prosthetic material duringdeployment, and resist retraction thereof to promote a secure closure.As shown, the edges of the needle guides 48-5 may additionally bebeveled, rounded, or otherwise configured to further facilitateadvancement thereof. In addition, each of the needle guides 48-5 inFIGS. 41 and 42 may be provided with generally linear constrictionelements 134-5 positioned to further secure an engagement between theneedle guide 48-5 and a corresponding needle 38, 40 or needle hook 46thereof. Moreover, the constriction elements 134-5 may serve to increasethe integrity or lateral rigidity of each needle guide 48-5 when aneedle 38, 40 is not inserted therethrough, such as when the suture 34-5is being moved along the tracks 36 of the elongate member 22 of asuturing device 20. Furthermore, the constriction elements 134-5 maycontinue to provide lateral rigidity and support for the retentionelements 132-5 once deployed and released into tissue and/or prostheticmaterial. For example, once the suture 34-5 is deployed and needleguides 48-5 are released from the corresponding needles 38, 40, theconstriction elements 134-5 may be configured to prevent the retentionelements 132-5 from collapsing and retracting from the tissue and/orprosthetic material.

In addition, the suture 34-5 of FIGS. 41 and 42 may further include oneor more nesting elements 144, or extended features disposed along theelongated filament 130-5, which may be sized and configured todetachably couple to a counterpart section of an adjacent suture 34-5 ina string of sutures 34-5. As shown in FIG. 43, for example, each nestingelement 144 may be configured to couple to the tip of the needle guide48-5 of an adjacent suture 34-5. Correspondingly, the tips of eachneedle guide 48-5 may be beveled, rounded, or otherwise sized and shapedto be mateably received within the nesting elements 144 of an adjacentsuture 34-5. In such a way, each suture 34-5 may include two sets ofnesting elements 144, such as forward-facing nesting elements 144 forcoupling to the trailing needle guide 48-5 of a preceding suture 34-5,and rearward-facing nesting elements 144 for coupling to the leadingneedle guide 48-5 of a subsequent suture 34-5. Furthermore, the nestingelements 144 may be coupled to corresponding sections of adjacentsutures 34-5 using, for example, flexible bonding material or adhesives,friction fitments, attenuated connections, or any other suitablearrangement that is, not only capable of maintaining rigidity of thestring of sutures 34-5 prior to deployment, but also capable of beingeasily detached so as not to interfere with deployment.

From the foregoing, it can be seen that the present disclosure setsforth a medical fastening or suturing device adapted to rapidly andreliably install fasteners or sutures to secure tissue and/or anyapplicable prosthetic material. The device not only greatly reduces thetime required for fastening tissues, but also results in improved easeof use relative to other methods. Furthermore, through the uniquecombination of elements set forth in the present disclosure, the tissuefastening or suturing is more reliably retained with reduced irritationand other complications to the patient and without adversely affectingthe integrity of the attachment and/or closure.

What is claimed is:
 1. A suturing device, comprising: a firing aperturehaving at least one needle rotatably disposed therein, the needle beingconfigured to engage a suture for deployment; a drive mechanismoperatively coupled to the needle and configured to advance the needlefrom a retracted position to an extended position during engagement, andretract the needle from the extended position to the retracted positionduring disengagement; and an autoloading mechanism operatively coupledto the drive mechanism and configured to slidably retrieve and positiona suture to be deployed over the firing aperture after a prior suturehas been deployed.
 2. The suturing device of claim 1, wherein the needleincludes a low-profile arcuate geometry configured to be substantiallyconcealed within the firing aperture when in the retracted position andhaving maximized reach during advancement thereof, the needle furtherincluding a hook configured to engage a suture for deployment.
 3. Thesuturing device of claim 1, wherein the firing aperture further includesa second needle rotatably disposed therein configured to engage a suturefor deployment, the drive mechanism being configured to advance andretract the first and second needles in substantially equal incrementsbut in opposing directions.
 4. The suturing device of claim 1, whereinthe drive mechanism includes a multi-bar linkage that is operativelycoupled to the needle, each multi-bar linkage having at least a drivelink and an intermediate link coupled between the drive link and theneedle.
 5. The suturing device of claim 1, wherein the autoloadingmechanism includes a shuttle slidably disposed in communication betweenthe firing aperture and one or more successively deployable sutures, theshuttle being configured to automatically retrieve one of the deployablesutures during deployment of a prior suture, and position the deployablesuture over the firing aperture upon full deployment of the priorsuture.
 6. The suturing device of claim 1, wherein the autoloadingmechanism includes a shuttle slidably disposed in communication betweenthe firing aperture and one or more successively deployable sutures, theautoloading mechanism further including a spring configured to bias theshuttle toward the firing aperture, and a shuttle pawl coupled to thedrive mechanism configured to pull the shuttle toward the deployablesutures during disengagement of the drive mechanism until at least theshuttle engages one of the deployable sutures, the shuttle pawlreleasing the shuttle and enabling the spring to send the shuttle andthe engaged suture to the firing aperture upon full deployment of aprior suture.
 7. The suturing device of claim 6, wherein the autoloadingmechanism further includes a declutch feature for releasing the shuttlefrom the shuttle pawl, the declutch feature being positioned relative tothe shuttle pawl such that the declutch feature declutches the shuttlepawl from the shuttle at least once one of the deployable sutures isengaged and the prior suture is fully deployed.
 8. The suturing deviceof claim 6, wherein the shuttle further includes one or more suturepawls for engaging one of the deployable sutures, the suture pawls beingconfigured to be engaging when the shuttle moves toward the firingaperture and non-engaging when the shuttle moves away from the firingaperture, the suture pawls being configured to position an engagedsuture on the firing aperture such that a needle guide of the suture isaligned with and engageable by the needle during deployment.
 9. Thesuturing device of claim 1, wherein the firing aperture includes arelease mechanism configured to release an engaged suture from theneedle during disengagement of the drive mechanism.
 10. The suturingdevice of claim 1, wherein the firing aperture includes a releasemechanism having a cutting edge disposed within the firing aperture andproximate to the needle in the retracted position, the cutting edgebeing positioned such that an engaged suture is cut and released fromthe needle when the needle returns to the retracted position.
 11. Thesuturing device of claim 1, wherein the firing aperture includes aplurality of needles rotatably disposed therein configured to engage asuture for deployment, the drive mechanism being configured to advanceand retract the plurality of needles.
 12. A suturing device, comprising:an elongate member extending between a working end and a control end andhaving a track for receiving one or more deployable sutures therein, theworking end having a firing aperture disposed in communication with thetrack and a distal needle and a proximal needle rotatably disposedtherein; a drive mechanism disposed within the elongate member andoperatively coupling the control end with each of the distal andproximal needles, the drive mechanism being configured to advance eachof the distal and proximal needles from a retracted position to anextended position during engagement, and retract each of the distal andproximal needles from the extended position to the retracted positionduring disengagement; and an autoloading mechanism disposed along theelongate member and proximate the working end, the autoloading mechanismoperatively coupled to the drive mechanism and configured to slidablyretrieve and position one of the deployable sutures over the firingaperture for deployment after a prior suture has been deployed.
 13. Thesuturing device of claim 12, wherein the drive mechanism includes atleast a distal drive link operatively coupled to the distal needle and aproximal drive link operatively coupled to the proximal needle, thedistal and proximal drive links being configured to advance and retractthe distal and proximal needles in substantially equal increments but inopposing directions.
 14. The suturing device of claim 13, wherein thedistal drive link is pivotally coupled to the distal needle via at leasta distal intermediate link and the proximal drive link is pivotallycoupled to the proximal needle via at least a proximal intermediatelink.
 15. The suturing device of claim 13, wherein the control endincludes a triggering mechanism for operating the drive mechanism, thetriggering mechanism including at least a reversing lever coupled toeach of the distal and proximal drive links, the reversing lever beingconfigured to drive the distal and proximal drive links and thecorresponding distal and proximal needles in substantially equalincrements but in opposing directions in response to triggering actionsreceived at the control end.
 16. The suturing device of claim 13,wherein the control end includes a triggering mechanism having a handlethat is operable in one of an engaging motion and a disengaging motion,the triggering mechanism being configured such that operating the handlein the engaging motion slidably drives the distal drive link toward theworking end and the proximal drive link toward the control end, andoperating the handle in the disengaging motion slidably drives thedistal drive link toward the control end and the proximal drive linktoward the working end, the triggering mechanism being configured todrive the distal and proximal drive links and the corresponding distaland proximal needles in substantially equal increments but in opposingdirections.
 17. The suturing device of claim 13, wherein at least one ofthe distal drive link and the proximal drive link includes a pluralityof catches incrementally disposed thereon, and the autoloading mechanismincludes a pusher slidably disposed along the track having one or morepusher tabs extending therefrom, the pusher tabs being configured tounidirectionally interface with the catches such that engaging any oneor more of the distal drive link and the proximal drive link also movesthe pusher toward the firing aperture.
 18. The suturing device of claim12, wherein the autoloading mechanism includes a shuttle slidablydisposed along the track of the elongate member in communication betweenthe firing aperture and one or more deployable sutures, the shuttlebeing configured to automatically retrieve one of the deployable suturesduring deployment of a prior suture, and position the deployable sutureover the firing aperture upon full deployment of the prior suture. 19.The suturing device of claim 12, wherein the autoloading mechanismincludes a shuttle slidably disposed along the track of the elongatemember in communication between the firing aperture and one or moredeployable sutures, the autoloading mechanism further including a springdisposed within the elongate member and configured to bias the shuttletoward the firing aperture, and a shuttle pawl coupled to the distaldrive link configured to pull the shuttle toward the one or moredeployable sutures during disengagement of the drive mechanism until atleast the shuttle engages one of the deployable sutures, the shuttlepawl releasing the shuttle and enabling the spring to send the shuttleand the engaged deployable suture to the firing aperture upon fulldeployment of a prior suture.
 20. The suturing device of claim 19,wherein the autoloading mechanism further includes a declutch featurefor releasing the shuttle from the shuttle pawl, the declutch featurebeing fixedly disposed within the elongate member relative to theshuttle pawl such that the declutch feature declutches the shuttle pawlfrom the shuttle at least once one of the deployable sutures is engagedand the prior suture is fully deployed.
 21. The suturing device of claim19, wherein the shuttle further includes one or more suture pawls forengaging with one of the deployable sutures, the suture pawls beingconfigured to be engaging when the shuttle moves toward the firingaperture and non-engaging when the shuttle moves away from the firingaperture, the suture pawls being configured to position an engagedsuture on the firing aperture such that one or more needle guides of thesuture is aligned with and engageable by at least one of the distal andproximal needles during deployment.
 22. The suturing device of claim 12,wherein the firing aperture includes a release mechanism having a distalcutting edge disposed within the firing aperture proximate to the distalneedle in the retracted position, and a proximal cutting edge disposedwithin the firing aperture proximate to the proximal needle in theretracted position, the distal and proximal cutting edges beingpositioned such that an engaged suture is cut and released from thedistal and proximal needles when the distal and proximal needles returnto the corresponding retracted positions during disengagement of thedrive mechanism.